颈淋巴结阴性鼻咽癌颈部的放射治疗

背景与目的:颈淋巴结阴性鼻咽癌(简称N0鼻咽癌)约占全部鼻咽癌病例的20%～30%,对这部分患者,治疗规范是在照射鼻咽病灶的同时预防照射双上颈部。但有些研究者主张行全颈预防照射。本研究分析和比较上颈部预防照射和全颈预防照射的颈部复发率和生存率的影响,以探讨N0鼻咽癌颈部的放射治疗。方法:选取178例经病理组织学确诊的N0鼻咽癌患者,其中88例接受上颈预防照射(上颈照射组),90例接受全颈预防照射(全颈照射组)。用Kaplan-M eier和log-rank法计算和比较两组生存率,用Cox模型分析影响预后的因素。结果:上颈照射组和全颈照射组的1、3、5年生存率分别为98.9%、90.9%、80.7%和97.8%、80.0%、71.1%(P=0.224);1、3、5年无瘤生存率分别是93.2%、80.7%、77.3%和85.6%、68.9%、64.4%(P=0.163);颈部复发率分别是1.14%和1.08%(P>0.05)。多因素分析显示:性别、T分期和近期疗效是影响N0鼻咽癌预后的独立因素。结论:对于颈淋巴结阴性鼻咽癌患者只需作上颈预防性照射。

Radiotherapy on neck for nasopharyngeal carcinoma patients with negative cervical lymph node

BACKGROUND & OBJECTIVE: Nasopharyngeal carcinoma (NPC) patients with negative cervical lymph node (N0-NPC) account for 20% -30% of all NPC patients. Prophylactic irradiation to the upper neck is a criterion of treatment for these patients. But some authors suggest to prophylactically irradiate the the whole neck. This study was to analyze and compare long-term outcomes of the N0-NPC patients treated by prophylactic irradiation to the upper neck and to the whole neck, and explore radiotherapy on neck for N0-NPC patients. METHODS: A total of 178 N0-NPC patients, proved by pathology, were treated in our hospital from Jul. 1998 to Dec. 1999. Of the 178 patients, 88 received prophylactic irradiation to the upper neck (upper neck group), 90 received prophylactic irradiation to the whole neck (whole neck group). Kaplan-Meier method and log-rank test were used to analyze and compare survival rate of the 2 groups. Cox model was used to study prognostic factors of N0-NPC. RESULTS: The 1-, 3-, and 5-year overall survival rates were 98.9%, 90.9%, and 80.7% in upper neck group, and 97.8%, 80.0%, and 71.1% in whole neck group (P = 0.224). The 1-, 3-, and 5-year disease-free survival rates were 93.2%, 80.7%, and 77.3% in upper neck group, and 85.6%, 68.9%, and 64.4% in whole neck group (P = 0.163). The incidence of cervical lymph nodes recurrence was 1.14% in upper neck group, and 1.09% in whole neck group (P> 0.05). Multivariate analysis showed that gender, T stage, and short-term outcome were independent prognostic factors of N0-NPC. CONCLUSION: Prophylactic irradiation to upper neck is recommended for N0-NPC patients.